Advanced Specialty Associates, LTD
Organization Active NPI Facial Plastic Surgery Physician · Baxter, MN
NPI 1265583652 · NPPES record last updated Sep 19, 2023
Key facts
- NPI
- 1265583652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Facial Plastic Surgery Physician 207YS0123X
- License
- 37843 (MN)
- Legal business name
- ADVANCED SPECIALTY ASSOCIATES, LTD
- Practice address
- 13359 Isle Dr
Suite 1
Baxter, MN 56425-2221 - Phone
- (218) 454-8888
- Fax
- (888) 835-7231
- NPI assigned
- Jan 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Kurtis Allen Waters, M.D.
- Title
- Director
- Phone
- (218) 454-8888
Practitioners 4
-
Ethan Terry Kraft, M.D.
-
Philip Manger, MD
-
Kurtis Allen Waters, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2016540 | Kurtis Waters MD PA | Provider-performed microscopy | Nov 18, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070308000273 | MN | Part B Supplier - Clinic/Group Practice | 0446353643 |
Receives reassigned benefits from 4 practitioners Practice locations: Baxter, MN |
National Provider Directory
Locations
13114 Isle Dr
Baxter, MN 56425
Phone (218) 822-2400
13359 Isle Dr
Ste 1
Brainerd, MN 56425
Phone (218) 454-3077
720 Main St
Ste 209
Mendota Heights, MN 55118
Phone (612) 464-5239
991 Sibley Memorial Hwy
Ste 20
Saint Paul, MN 55118
991 Sibley Memorial Hwy
Ste 200
Saint Paul, MN 55118
Interoperability endpoints
- kwaters@directaddress.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Facial Plastic Surgery Physician |
207YS0123X | 37843 | MN | Yes |
Addresses
Primary practice location
13359 Isle Dr
Suite 1
Baxter, MN 56425-2221
Mailing address
13359 Isle Dr
Suite 1
Baxter, MN 56425-2221
Phone (218) 454-8888
Other practice location 1
720 Main St Ste 209
Mendota Heights, MN 55118-1800
Phone (612) 464-5239
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 930218200 | Medicaid | MN | |
| 422K7WA | Other | MN | BLUE CROSS BLUE SHIELD MN |
Other names
- Advanced Specialty Associates
- Kurtis A Waters MD PA
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kwaters@directaddress.net | Health Information Exchange (HIE) |
Other providers in Baxter, MN
- Aaron Hokanson, D.C., P.a.
- Accucare Audiology & Hearing Solutions, LLC
- Lyssa Adams
- Adil Taha Dba Hannibal Transportation
- Dorraine Sue Adkins-Carlson
- Andrea Frances Agre
- Beatriz Aguilar
- Anna M Ahrendt-Madsen
- Aim-Axness Integrative Medicine, PLLC
- Seraphine Aker
All providers in Baxter, MN · Facial Plastic Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.